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3. Mothers Name:
5. Permanent address
House No. Street City District State Mobile No.
6. Date of birth
D D M M Y Y Y Y
7.
Male
Female
9. Details of college/institution (i) (ii) (iii) (iv) (v) Name of the college/institution where admitted: Address of college/institution: Telephone no: E-mail address: To which university is it affiliated/does it have deemed university
status:
Signature